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PubMed2002

Transconjunctival upper blepharoplasty: a safe and effective addition to facial rejuvenation techniques.

Transconjunctival techniques for eyelid rejuvenation are now well accepted in the lower eyelid. Transconjunctival upper blepharoplasty is a relatively new technique for which overall experience has been limited. Since October 1998, the authors performed 42 bilateral transconjunctival upper blepharoplasties on patients undergoing facial and eyelid rejuvenation. They describe the essential anatomy and technique of the procedure. The CO2 laser is used concomitantly for treating fine rhytids and tightening loose upper eyelid skin. This procedure is an effective method of removing medial upper eyelid fat with minimal complications.

Blepharoplasty↗
PubMed2001

The ultimate in facial rejuvenation: the mid-facelift.

Facial rejuvenation in 2001 encompasses a plethora of areas. Facial rejuvenation begins with excellent skin health, incorporating appropriate surgical procedures and an overall holistic approach to facial surgery. Appearance is important. Aesthetic surgery, particularly of the face, offers women the chance to turn back the hands of time.

Humans↗
PubMed1995

Arcus marginalis release and orbital fat preservation in midface rejuvenation.

With aging, the periorbital area reveals progressive exposure of underlying skeletal anatomy as compared with the lower areas of the face, whose thicker soft tissues continue to cover underlying bony landmarks. With recent techniques in cheek fat repositioning and orbicularis muscle repositioning, rejuvenation results of the midface have been markedly improved. Conventional lower blepharoplasty techniques that remove lower eyelid fat can create a concave contour deformity of the lower eyelids that causes the "operated" appearance. This paper describes a new technique to preserve the lower eyelid fat and to advance it beyond the infraorbital rim. An arcus marginalis release is accomplished, and the subseptal fat is advanced and sutured beyond the entire infraorbital rim and under the repositioned orbicularis muscle. By camouflaging the lower orbital rim anatomy, rejuvenation of the midface is more complete. A total of 152 cases have been done over a 3-year period with impressive results and minimal complications. This procedure is done in all composite rhytidectomies and in isolated blepharoplasty patients without advanced facial aging. It is particularly indicated in secondary procedures correcting overresection of orbital fat or deformities resulting from malar augmentation.

Adipose Tissue↗
PubMed1997

Refinements in endoscopic forehead rejuvenation.

Endoscopic forehead technique provides an effective method for rejuvenation of the upper face. Distinct advantages of this technique over classic methods of forehead rejuvenation such as coronal or subcutaneous approaches include significant reduction of incisional scars. Described here are three refinements related to (1) control of hair, (2) differential release of the periosteum, and (3) advanced fixation methods. Control of hair can be achieved simply by braiding and the use of an Endoscopic Access Device. Extensive release of the periosteum and arcus marginalis is recommended laterally, while elevating the medial periosteum either intact or with conservative release. Different and technologically more advanced fixation methods are described to provide better control of elevated forehead. Incorporation of these refinements strives to optimize aesthetic results while minimizing operative morbidity. These refinements have been implemented during the care of 29 patients and have proven to be of major value in achieving greater patient satisfaction and technical advancement.

Endoscopes↗
PubMed1997

Evolving fixation methods in endoscopically assisted forehead rejuvenation: controversies and rationale.

The goals of surgical rejuvenation of the forehead include component brow manipulation, attenuation of transverse forehead rhytids, and reduction of glabellar frown lines. The endoscopic approach has proved successful in achieving these goals in selective patients while minimizing incisions and improving scalp sensation. Efficacy of endoscopic brow manipulation is dependent on (1) complete release of the brow at the supraorbital rim, (2) brow depressor muscle resection/release, and (3) tension-free fixation of the brow position until wound healing has occurred. Fixation of the brow using an endoscopic technique, unlike the open technique, is dependent on skin retraction and tension-free scalp fixation during the process of wound healing to maintain the desired brow position. Techniques for endoscopic fixation are arbitrarily divided into endogenous and exogenous. Endogenous methods include extensive galea-frontalis-occipitalis release, lateral spanning suspension sutures, external bolster fixation, anterior port skin excision, galea-frontalis advancement, cortical tunnels, and tissue adhesives. Exogenous techniques include internal screw or plate fixation, Mitek anchor fixation, external screw fixation, and absorbable K-wires. This article provides a goal-oriented review of these evolving techniques and a rationale for the use of fixation methods in endoscopically assisted forehead rejuvenation.

Bone Plates↗
PubMed2000

Relevance of the lesser occipital nerve in facial rejuvenation surgery.

Nerve injuries are possible during facial rejuvenation surgery. The great auricular nerve has been studied; however, little is known about the lesser occipital nerve and its relevance in facial rejuvenation surgery. To understand the importance of the lesser occipital nerve in a face lift procedure, the specific anatomy of the nerve was studied in the laboratory in 19 hemifaces, with additional nerve observations in the operating room. The course of the lesser occipital nerve, its branches, and the relationship with the surrounding structures were evaluated and recorded. The great auricular nerve was also dissected to compare the two nerve territories. In the majority of the dissections, the lesser occipital nerve supplied the superior ear and the mastoid area, whereas the great auricular nerve innervated the inferior ear and a portion of the preauricular area. The nerves, however, were variable in size and distribution. Five lesser occipital nerves provided the dominant supply to the ear, compensating for a small great auricular nerve contribution. Therefore, injury to the lesser occipital nerve can result in a major sensory deficit of the ear. We also found the lesser occipital nerve to have a subcutaneous course at a proximal and variable level. These nerve branches can be superficial, and therefore postauricular flap dissection can injure the nerve if the flap is dissected at the fascial level. We therefore suggest that the dissection be at a more superficial level to avoid nerve injury. And finally, if SMAS/platysma suspension sutures are placed, we suggest these be done in a vertical-oblique direction along the course of the lesser occipital nerve, because this should minimize the possibility of trapping terminal branches.

Cranial Nerves↗
PubMed2002

Applications of the classic dermal fat graft in primary and secondary facial rejuvenation.

Volumetric facial aging occurs primarily as a descent of facial soft tissues, followed by their secondary atrophy. Proper volumetric facial rejuvenation, therefore, demands effective superior redistribution of fallen soft tissues, for which the author prefers malar imbrication. Only then do augmentative adjustments become appropriate, including solid facial protheses, "soft-tissue" fillers, dermal fat grafts, free-fat micrografts, and Erol's "tissue-cocktail." Of these, the author prefers the time-honored dermal fat graft for all primary volumetric augmentations within the surgical field, reserving free-fat micrografts for adjustments outside the field and those performed secondarily. Dermal fat grafts are added to the face in three categories: "camouflage" grafts from the anterior face lift discard specimen to correct contour irregularities in the sculpted subcutaneous cheek in half of patients; "transition" grafts from the suprapubic abdomen to the zone between the midface and lower face in 5 percent of patients with an emaciated quality to their aging; and "secondary" grafts from the abdomen in occasional patients with volumetric deformities following inexpert face lift and other forms of trauma. All grafts were harvested, prepared, and placed according to 10 straightforward technical principles. The grafts were highly effective and predictable in their ability to augment contour; none of 283 total grafts were regarded as a treatment failure. The use of such grafts was extremely safe, with complications limited to cyst formation in 1.5 percent of grafts, all of which were treated nonoperatively. The use of the dermal fat graft is seen as safe, effective, and convenient when the subcutaneous plane of the face is exposed during facial rejuvenation. The majority of grafts were derived from the face lift discard specimen. Although those that came from outside the head and neck presented extra inconvenience and operative time, their use was limited to occasional and challenging circumstances that justified extra investment.

Adipose Tissue↗
PubMed2004

Incidence of earlobe ptosis and pseudoptosis in patients seeking facial rejuvenation surgery and effects of aging.

The authors have previously described a classification system for earlobe ptosis and have established a criterion for earlobe pseudoptosis. Earlobe heights were characterized based on anatomic landmarks, including the intertragal notch, the otobasion inferius (the most caudal anterior attachment of the earlobe to the cheek skin), and the subaurale (the most caudal extension of the earlobe free margin). The classification system was derived from earlobe height preferences as determined by a survey of North American Caucasians, and it identified the ideal free caudal lobule height range to measure 1 to 5 mm from otobasion inferius to subaurale (grade I ptosis). Also, earlobe pseudoptosis was defined by the attached cephalic lobule height measuring an intertragal notch to otobasion inferius distance greater than 15 mm. In this study, the preoperative earlobe height measurements of 44 patients seeking facial rejuvenation were evaluated. The average attached cephalic segment (intertragal notch to otobasion inferius distance) of patient earlobes measured 11.10 +/- 0.46 mm, and the average free caudal segment (otobasion inferius to subaurale distance) of patient earlobes measured 7.15 +/- 0.49 mm. Assessment of patient groups based on single-decade age differences demonstrated an increase in the free caudal segment (otobasion inferius to subaurale distance) with increasing age (p = 0.003). Assessment of patient groups based on single-decade age differences demonstrated no increase in the attached cephalic segment (intertragal notch to otobasion inferius distances) with increasing age (p = 0.281). When evaluating for the ideal otobasion inferius to subaurale distance, only 22.2 percent of earlobes demonstrated an ideal free caudal earlobe height (grade I ptosis). Moreover, pseudoptosis was detected in 12.3 percent of earlobes. Finally, a majority of earlobes demonstrated intrapatient variability, with only 16.2 percent of patients demonstrating identical attached cephalic segment (intertragal notch to otobasion inferius distances) and 37.8 percent demonstrating identical free caudal segment (otobasion inferius to subaurale distances) when compared with their contralateral ear. Plastic surgeons should be aware that a significant number of patients (77.8 percent of earlobes) may not possess an ideal free caudal segment and that 12.3 percent of earlobes may present with pseudoptosis. Therefore, earlobe height assessment should be an essential aspect of evaluation in patients desiring facial rejuvenation surgery. Evaluation of both ears should be performed independently due to intrapatient earlobe height variations. Finally, patients should be counseled with regard to the ideal earlobe parameters and aging patterns (stable attached cephalic segment versus increasing free caudal segment). With the natural progression of both facial rhytides and caudal segment earlobe ptosis (increasing free lobule segment) with increasing age, independent and accurate assessment of earlobe height is indicated so that the aging ear may be addressed concurrently with the aging face.

Adult↗
PubMed2004

The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation.

Resetting of the septum orbitale over the orbital rim, or "septal reset," is the latest step in achieving periorbital rejuvenation in composite rhytidectomy. The first significant step was the addition of orbicularis repositioning to conventional lateral vector deep plane rhytidectomy, followed by orbital fat preservation using the arcus marginalis release and fat transposition over the orbital rim. Those early procedures have been further refined to include the zygomaticus muscles with the orbicularis oculi in the composite flap, or zygorbicular cheek flap, and a septal reset. The septum orbitale reset has distinct advantages over transposition of orbital fat alone, as it creates a firmer undersurface for the lower eyelid. This maneuver will create a truly youthful lower eyelid-cheek complex, as the normal concave aging skeletonization of the periorbit is transformed to a convex contour of youth. The effectiveness of this operation can be demonstrated in most variations of human anatomy, whether congenital or iatrogenic, allowing the plastic surgeon to utilize the septal reset in virtually every patient undergoing and desiring a harmonious facial rejuvenation.

Adipose Tissue↗
PubMed2003

Temperature chaos, rejuvenation, and memory in Migdal-Kadanoff spin glasses.

We use simulations within the Migdal-Kadanoff approach to probe the scales relevant for rejuvenation and memory in Ising spin glasses. First we investigate scaling laws for domain wall free energies and extract the chaos overlap length l(T,T'). Then we perform out of equilibrium simulations that follow experimental protocols. We find that (1) a rejuvenation signal arises at a length scale significantly smaller than l(T,T'), and (2) memory survives even if equilibration goes out to length scales larger than l(T,T'). Theoretical justifications of these phenomena are then considered.

Journal Article↗
PubMed2004

Energy landscape picture of overaging and rejuvenation in a sheared glass.

Molecular simulations and an energy landscape analysis are used to investigate the effects of shear on aging in a glass. Shear beyond the yield point is shown to change the state of a glass such that it resembles (but is not identical to) a different stage in the aging process. A cycle of large strain rejuvenates the glass by relocating the system to shallower energy minima, while a cycle of small strain overages the glass by relocating the system to deeper energy minima. The balance between overaging and rejuvenation is controlled by how well the glass was initially annealed.

Journal Article↗
PubMed1985

Behavior of Lipoxygenase during Establishment, Senescence, and Rejuvenation of Soybean Cotyledons.

Lipoxygenase protein and activity were examined during establishment, senescence, and rejuvenation of soybean cotyledons. Lipoxygenase protein, as determined on ;Western' immunoblots, and lipoxygenase-1 and -2/3 activities decreased during mobilization of seed reserves 3 to 9 days following planting. Lipoxygenase-1 activity decreased more rapidly than lipoxygenase-2/3 and was not detectable by 11 days after planting. Lipoxygenase protein increased after day 11 while lipoxygenase-2/3 activity continued to decline. During the later stages of cotyledon senescence, both lipoxygenase protein and lipoxygenase-2/3 activity decreased. Upon rejuvenation, lipoxygenase-2/3 activity, but not that of lipoxygenase-1, increased. These results demonstrate that elevated lipoxygenase activity does not represent a universal characteristic of senescent plant tissue.

Journal Article↗
PubMed2006

Facial assessments: identifying the suitable pathway to facial rejuvenation.

OBJECTIVES: There are now numerous ways in which a patient can rejuvenate their facial appearance, including various types of expensive, invasive, surgical procedures, and an ever increasing gamut of products that can be inserted or injected beneath the skin to restore a youthful look to the face. The importance of facial assessments in identifying the most suitable treatment option is discussed here. RESULTS: Before a patient commits to any one of these corrective options, it is the responsibility of the physician to conduct a thorough assessment of the patient's face. All of the facial characteristics should be examined closely: underlying bone and musculature, shape, proportion, and features including folds, wrinkles, fine lines, volume deficits and changes in pigmentation. The degree of ptosis in the facial tissues should be assessed by light palpation. Following assessment of the face, digital photographs should be taken of the patient's full face and profile, allowing the physician to indicate areas, on a visual display, that need correction and there are now computer programs which can 'morph' the features of a facial photograph, providing an approximation of the post-treatment result. Shape and proportion are neglected facets in the assessment of the face prior to corrective treatment. A treatment or technique which rejuvenates a 'thin' face may not work so successfully on a 'round' face and vice versa. Most importantly, the physician should aim to understand the patient's objective and subjective perceptions of their face and ascertain the results that are desired by the patient before evaluating what can be achieved. Appropriate corrective options can then be discussed in detail, highlighting the risks, side effects, costs, invasiveness, logistics and anticipated outcomes of each. CONCLUSION: A comprehensive assessment of the patient's face allows the physician to formulate a regimen of treatments that will reach or exceed the expectations of the patient.

Cosmetic Techniques↗
PubMed2005

Nonablative skin rejuvenation.

Laser resurfacing of photodamaged or scarred skin has traditionally involved the use of ablative lasers with their associated limitations and side effects. Nonablative skin rejuvenation is a relatively new concept in facial rejuvenation, which aims to induce dermal remodeling without visible epidermal disruption. A number of laser devices and light sources, emitting at various wavelengths, have been shown to effectively enhance the appearance of facial skin through nonablative mechanisms. Among the conditions that can be treated with this novel modality are erythema, telangiectasia, pigmentation, lentigines, and textural imperfections ranging from fine and moderate rhytides to other surface irregularities such as acne scarring. A major attraction of nonablative laser therapy is the very limited downtime after each treatment, making it an ideal method for patients seeking a minimally invasive procedure with an excellent safety profile.

Journal Article↗
PubMed2006

Employing a teaching module improves patient satisfaction in facial rejuvenation.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine whether a teaching module for facial rejuvenation improved patient satisfaction and enhanced practice growth in a cosmetic surgery office. An educational module was designed to review soft-tissue anatomy and physiology, treatment options, and outcomes. MATERIALS AND METHODS: During the initial office consultation, the module was utilized in group A (50 patients) but not in group B (50 patients). Satisfaction surveys were taken from all patients following the consultation. Patients from both groups who scheduled procedures were surveyed following completion of treatment. RESULTS: The surveys indicated a statistically significant higher level of satisfaction with the consultation, a better understanding of treatment options, and a greater percentage of treatment scheduling in group A patients (P < 0.05). Furthermore, patients in group A who underwent treatment indicated greater satisfaction with treatment outcome when compared to those treated patients in group B (P < 0.05). CONCLUSIONS: We conclude that use of a well-designed teaching module helps patients better understand the concepts behind facial rejuvenation and leads to increased procedure scheduling and greater patient satisfaction following treatment.

Algorithms↗
PubMed1972

Model approach to immunological rejuvenation of the aged.

Reconstitution of a damaged or exhausted immune system by injection of genetically compatible immunocompetent cells (immunologic rejuvenation) is a promising approach for restoration of immune activity. By using this model, spleen cells from young-adult mice, previously immunized with Salmonella typhimurium, were transferred to either young-adult or old, syngeneic recipients before or after storage at -196 C. The susceptibility of recipient mice was then determined by challenging them at increasing time intervals after reconstitution with lethal doses of the virulent organisms. The findings, although preliminary in nature, demonstrate that (i) immunological rejuvenation of mice is possible with immunocompetent cells from specifically immunized donors; (ii) prolonged "takes" of these cells can occur even in nonirradiated recipient mice, and (iii) storage at -196 C does not impair their protective capacity.

Aged↗
PubMed2002

Rheological aging and rejuvenation in solid friction contacts.

We study the low-velocity (0.1-100 microm s(-1)) frictional properties of interfaces between a rough glassy polymer and smooth silanized glass, a configuration which gives direct access to the rheology of the adhesive joints in which shear localizes. We show that these joints exhibit the full phenomenology expected for confined quasi-2D soft glasses: they strengthen logarithmically when aging at rest, and weaken (rejuvenate) when sliding. Rejuvenation is found to saturate at large velocities. Moreover, aging at rest is shown to be strongly accelerated when waiting under finite stress below the static threshold.

Journal Article↗
PubMed1997

[Endoscopic subperiosteal facial rejuvenation].

It is just recently that video endoscopic techniques began to be applied to facial rejuvenation in China. Since July 1995, the authors have performed 15 operations of subperiosteal rejuvenation under the video endoscope, combined with liposuction of the sub-mandible region and the nasolabial fold. The operation uses small incisions, produces satisfactory results with less edema, less numbness and without alopecia. The indications, instrumentation, surgical technique and results and presented and discussed. According to our clinical experience, the best candidates for this operation are those aged from 40 to 55. For the patients about sixty years old, a mini multiplane facelift should be carried out in the cheek and neck region following the subperiosteal facelift. The more elderly patients are not candidates for this operation. We emphasize that the dissected scalp flap should be uplifted to the maximum and anchored on the cranial bone to ensure a satisfactory result.

Adult↗